| Nicole Pan, Licensed Mental Health Counselor, Pllc | |
|
21 Greene Ave Suite 205 Amityville NY 11701-2943 | |
| (631) 637-0579 | |
| Not Available |
| Full Name | Nicole Pan, Licensed Mental Health Counselor, Pllc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 21 Greene Ave, Amityville, New York |
| Authorized Official Name and Position | Nicole Pan (LICENSED MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 6316370579 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicole Pan, Licensed Mental Health Counselor, Pllc Po Box 1245 Farmingdale NY 11735-0855 Ph: (631) 637-0579 | Nicole Pan, Licensed Mental Health Counselor, Pllc 21 Greene Ave Suite 205 Amityville NY 11701-2943 Ph: (631) 637-0579 |
| NPI Number | 1861897803 |
|---|---|
| Provider Enumeration Date | 11/04/2014 |
| Last Update Date | 05/25/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861897803 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 005554 (New York) | Primary |
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